| NPI | 1730506700 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD J. MARTIN Director 860-885-0444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery |
| Additional Taxonomies | 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck |
| Enumeration Date | 2014-03-27 |
| Last Update Date | 2014-03-27 |